Aim: To throw light on the causes and complication of hypocholesterolemia. Background: Hypocholesterolemia is defined as total cholesterol and low-density lipoprotein (LDL) level below the fifth percentile of the general population. It is usually an incidental finding on routine lipid screening and thus much clinical importance is not given to the same. Though the first case of hypocholesterolemia was published in 1911, decades have passed since then with only a handful of cases of hypocholesterolemia being reported implying either a general lack of knowledge regarding the causes and consequences of low cholesterol or a lack of awareness in the diagnosis of hypocholesterolemia. Hypocholesterolemia can be caused due to many reasons and can lead to many complications as well. Case description: We report three cases of hypocholesterolemia, which had very low levels of total cholesterol and LDL at our tertiary cardiac specialty hospital over a period of one year. Hypocholesterolemia in our cases could be attributed to a combination of statins, liver dysfunction, critical illness, and chronic inflammation. More extensive work needs to be done on this subject as the incidence of hypocholesterolemia is on the rise. Conclusion: Hypocholesterolemia is equally dangerous as compared to hypercholesterolemia and more research work needs to be undertaken in this field. Clinical significance: Understanding the causes and complications of hypocholesterolemia as well as knowing the underlying molecular basis is of crucial importance as it would provide new insights into the management of hypercholesterolemia and cardiovascular diseases in particular.